Parenting Programs

Introduction

In 2009, approximately 5 percent of U.S. children aged 4 through 17 were reported
as having serious socioemotional or behavioral difficulties, and 21 percent of U.S.
children in approximately the same age group were living in poverty.1
Emotional and behavioral health is important in building strong social relationships
and realizing full academic potential.1,
2 Poverty has been associated with lifelong cognitive, behavioral,
and socioemotional difficulties as well as fewer years in school and increased unemployment.1, 2 Parents and other caregivers
play a central role in recognizing and ameliorating such risk factors. Interventions
including parenting programs have shown both long-term efficacy and cost-effectiveness
in promoting the successful transition of children into healthy, productive adults.2 Parenting programs for child behavior problems
aim to help parents improve their relationship with their children and enhance their
parenting skills to prevent and cope with challenging behavior.

This report focuses on the efficacy of parenting programs that include child or
adolescent behavioral outcomes such as academic performance, conduct, delinquency,
or peer relations. Some parenting programs are universal, while others are targeted
to parents with specific problems such as mental health disorders, socioeconomic
challenges, domestic violence, child maltreatment, or substance abuse.2 Parenting programs may also be targeted to reduce
problem behavior in children with specific problems such as attention deficit disorder,
delinquency, socioemotional challenges, or traumatic stress from child abuse or
neglect.2 Parenting
programs are often multifaceted, with components that include not only parents but
also children, other family members, schools, and communities.2 The programs may take place in settings such
as homes, schools, or clinics and may be delivered through classroom curricula,
computer programs, or face-to-face contact with clinicians, counselors, teachers,
or other professionals.2
Parenting programs may start as early as preconception and continue through adolescence.2

Search Strategy and Criteria

An extensive search was conducted for systematic reviews published between January
1, 2000, and May 18, 2012. The search was limited to the online catalog of the U.S.
Government’s National Library of Medicine, PubMed (http://www.pubmed.gov)
to ensure free access to abstracts and in some cases full-text articles. Systematic
reviews reported in the context of guidelines, consensus statements, or studies
were not the target of the search.

The strategy to conduct the search was as follows: “Parenting” [Mesh] AND (systematic[sb]
OR Meta-Analysis[pt]) AND English[lang] AND "Humans"[MeSH Terms] AND "2000/01/01"
[PDAT]: "2012/05/18" [PDAT]

Each part of the strategy is described below:

Topics: The medical subject heading “parenting” used in
the search is defined by PubMed as “performing the role of a parent by care-giving,
nurturance, and protection of the child by a natural or substitute parent. The parent
supports the child by exercising authority and through consistent, empathic, appropriate
behavior in response to the child's needs.”

Additional limits: Limits were used restricting the search
to systematic reviews (with a separate designation for those containing meta-analyses)
and articles published in English, focused on humans, and published no earlier than
2000. The search was further narrowed by hand to those reviews focusing on parenting
programs that included child or adolescent behavioral outcomes.

Results

The literature search yielded a total of 11 systematic reviews. Of these, 9 included
a meta-analysis (Reviews 1, 3–8, 10, and 11). The average number of studies included
in the systematic reviews was 22 (range = 3–77; median = 15). Studies were conducted
in the United States and internationally. Settings for the parenting interventions
were not reported in all the included studies. The goal of the included interventions
was to examine the efficacy of parenting programs on the behavior of children who
were at risk for or displayed behavioral problems and on parents’ parenting skills
and positive behavior (e.g., sensitivity, stress management, self-confidence). Although
all the studies reported at least one or more outcome measures of child behavior,
parental outcome measures were also reported in most of the reviews. Behavior problems
were assessed exclusively in preschool-aged children (Reviews 1 and 7) and in school-aged
children up to age 18 (Reviews 2, 3–6, and 8–11). Four of the reviews included parents
of children and/or adolescents with a clinical diagnosis such as conduct disorder,
oppositional defiant disorder, attention deficit disorder, attention deficit hyperactive
disorder (ADHD), cerebral palsy, and conduct problems or delinquency (Reviews 3,
5, and 8–10). Two reviews focused on low-income families (Reviews 4 and 7), and
one examined which parenting program components were effective in reducing early
childhood behavior problems (Review 6). Overall, the parenting interventions had
significant positive effects on child behavioral problems and parenting skills and
behaviors.

Effects of Parenting Interventions by Population

Four reviews examined the effect of parenting interventions on parents of children
diagnosed with ADHD or with early onset conduct disorder and ADHD symptoms (Reviews
3, 5, 8, and 11). Parenting interventions significantly improved behaviors in children
with ADHD and improved parental mental health, parenting practices, and parenting
skills. Parenting interventions significantly decreased the amount of time delinquent
children and adolescents spent incarcerated and reduced the risk of arrests 1–3
years postintervention (Review 10). Parenting interventions for low-income or socially
disadvantaged families revealed mixed results. Specifically, interventions that
included video feedback (i.e., interventions that record parent-child interactions
so the parent can observe his or her parenting behaviors) had positive effects on
parent and child behaviors from low-income families (Review 4), while home-based
interventions for socially disadvantaged families were not effective (Review 7).
Research suggests that parenting interventions for parents of children with cerebral
palsy are effective in improving parent and child behaviors (Review 9).

Effects of Parenting Interventions by Type

Two reviews examined the Positive Parenting Program (Triple P), which is a stepped-care
program designed to prevent or treat behavioral, developmental, and emotional problems
in children from birth to 16 years (Reviews 3 and 8). Triple P had a positive effect
on parenting behavior and child behavior problems. The positive effects were maintained
6–12 months after the intervention. One review specifically examined behavioral
and cognitive-behavioral parent programs (Review 5), which are interventions that
teach parents how to reframe distorted cognitions and coach them in problem-solving
and anger management. These types of interventions significantly reduced child conduct
problems and negative parenting practices and significantly improved parental mental
health.

In sum, parenting interventions produced significantly positive results in parenting
behaviors and children’s behavioral problems across a diverse range of participants
at risk for or displaying behavioral problems. However, moderators on the effect
of parenting programs emerged such that larger long-term effects were found in studies
with a higher percentage of girls and studies with children who have initial behavior
problems in the clinical range (Review 3). Similarly, two reviews found interventions
had larger effects on parental reports of child outcomes than independent observations
(Reviews 1 and 8).

Systematic Reviews

Read the PDF for the descriptive information for each of the 11 systematic reviews.